Of the 257 participants who have enrolled in the existing OMS study to date, only 32 have withdrawn for all reasons. More than 1,100 charts among four participating Kaiser facilities have been assessed for potential inclusion in the study and nearly 120 participants have completed the study. Bi-weekly conference calls with NIH-RMD and collaborating team members are scheduled to provide opportunities to discuss progress of the study, address issues and coordinate next steps. Kaisers implementation of the existing OMS-PAC study has led to effective methods of tracking participants over time, yielding exceptional follow-up rates and successfully capturing all necessary data elements. Data collection for this portion of study will end when the sample size for the proxy-self report sub-study has been achieved. The projected sample size for the sub-study is 60, with current enrollment at 38. The implementation phase of the study has led to adjustments in CAT tool software and more effective and efficient procedures for communicating with study participants, tracking data and training research staff. In addition, implementation of the current OMS study has contributed to the emergence of new research questions. A proposed study modification will extend findings from the ongoing OMS-PAC study in order to examine change in health and functioning of adults following stroke over time, identify factors that may drive these changes, and examine the types of formal and informal care received for 2 years following the acute stroke. Thus, the proposed study will be descriptive in nature and serve as pilot work to provide estimates necessary for precise sample size calculations for future studies assessing the long-term health and functioning of adults following stroke. Continuing to follow the existing participant cohort provides a window of opportunity to collect data elements over a longer time period, while adding new data collection elements that will further contribute to the study of post-acute care outcomes. In this regard, a proposed study modification will follow the existing cohort of 200 adults until 2 years after their first acute stroke. While Phase I collects data until 6 months post stroke; the proposed research, Phase II, will continue to collect data at 12, 18 and 24 months post-stroke. The Phase I data elements include AM-PAC scores, social/role function instrument scores, and data elements available through Kaiser Permanentes existing databases which include socio-demographic information, occurrence of new (incident) conditions, and medication use. These data will now be collected at 12, 18 and 24 months. In addition, Phase II will include a fixed form module capturing information on family care giving and informal sources of support that will be added to the existing computerized data collection instrument. Finally, Kaiser Permanentes existing databases allow collection of information on health care service use of the cohort from 6 months to 24 months post stroke, the period of time encompassed in Phase II. Thus, the aims of Phase II are to 1) examine the health and functioning of adults with stroke from the end of Phase I (6 months post-stroke) to 2 years post-stroke; 2) examine factors that affect declines or improvements in health and/or functioning in this cohort; and 3) to describe ongoing health care use and informal sources of support with emphasis on family care giving.